Deck 29: Eye Disorders

Question 1

The primary care pediatric nurse practitioner observes a tender, swollen red
furuncle on the upper lid margin of a child's eye. What treatment will the nurse practitioner recommend?
A. Culture of the lesion to determine causative organism
B. Referral to ophthalmology for incision and drainage
C. Topical steroid medication
D. Warm, moist compresses 3 to 4 times daily

Answer 1

Warm, moist compresses 3 to 4 times daily

Question 2

A preschool­age child who attends day care has a 2­day history of matted eyelids
in the morning and burning and itching of the eyes. The primary care pediatric nurse practitioner notes yellow­green purulent discharge from both eyes, conjunctival erythema, and mild URI symptoms. Which action is correct?
A. Culture the conjunctival discharge.
B. Observe the child for several days.
C. Order an oral antibiotic medication.
D. Prescribe topical antibiotic drops.

Answer 2

Prescribe topical antibiotic drops.

Question 3

The primary care pediatric nurse practitioner applies fluorescein stain to a child's
eye. When examining the eye with a cobalt blue filter light, the entire cornea appears cloudy. What does this indicate?
A. The cornea has not been damaged.
B. There is too little stain on the cornea.
C. There is damage to the cornea.
D. There is too much stain on the cornea.

Answer 3

There is too much stain on the cornea.

Question 4

The primary care pediatric nurse practitioner is treating an infant with lacrimal duct
obstruction who has developed bacterial conjunctivitis. After 2 weeks of treatment with topical antibiotics along with massage and frequent cleansing of secretions, the infant's symptoms have not improved. Which action is correct?
A. Perform massage more frequently.
B. Prescribe an oral antibiotic.
C. Recommend hot compresses.
D. Refer to an ophthalmologist.

Question 5

A 14­year­old child has a 2­week history of severe itching and tearing of both
eyes. The primary care pediatric nurse practitioner notes redness and swelling of the eyelids along with stringy, mucoid discharge. What will the nurse practitioner prescribe?
A. Saline solution or artificial tears
B. Topical mast cell stabilizer
C. Topical NSAID drops
D. Topical vasoconstrictor drops

Question 6

The primary care pediatric nurse practitioner performs a well baby assessment of
a 5­day­old infant and notes mild conjunctivitis, corneal opacity, and serosanguinous discharge in the right eye. Which course of action is correct?
A. Administer intramuscular ceftriaxone 50 mg/kg.
B. Admit the infant to the hospital immediately.
C. Give oral erythromycin 30 to 50 mg/kg/day for 2 weeks.
D. Teach the parent how to perform tear duct massage.

Question 7

A toddler exhibits exotropia of the right eye during a cover­uncover screen. The
primary care pediatric nurse practitioner will refer to a pediatric ophthalmologist to initiate which treatment?
A. Botulinum toxin injection
B. Corrective lenses
C. Occluding the affected eye for 6 hours per day
D. Patching of the unaffected eye for 2 hours each day

Question 8

During a well child exam on a 4­year­old child, the primary care pediatric nurse
practitioner notes that the clinic nurse recorded "20/50" for the child's vision and noted that the child had difficulty cooperating with the exam. What will the nurse practitioner recommend?
A. Follow up with a visual acuity screen in 6 months.
B. Refer to a pediatric ophthalmologist.
C. Re­test the child in 1 year.
D. Test the child's vision in 1 month.

Question 9

The primary care pediatric nurse practitioner performs a Hirschberg test to evaluate
A. color vision.
B. ocular alignment.
C. peripheral vision.
D. visual acuity.

Question 10

The primary care pediatric nurse practitioner performs a vision screen on a 4­
month­old infant and notes the presence of convergence and accommodation with mild esotropia of the left eye. What will the nurse practitioner do?
A. Patch the right eye to improve coordination of the left eye.
B. Reassure the parents that the infant will outgrow this.
C. Recheck the infant's eyes in 2 to 4 weeks.
D. Refer the infant to a pediatric ophthalmologist.

Question 11

The primary care pediatric nurse practitioner performs a well child examination on
a 9­month­old infant who has a history of prematurity at 28 weeks' gestation. The infant was treated for retinopathy of prematurity (ROP) and all symptoms have resolved. When will the infant need an ophthalmologic exam?
A. At 12 months of age
B. At 24 months of age
C. At 48 months of age
D. At 60 months of age

Question 12

A school­age child is hit in the face with a baseball bat and reports pain in one
eye. The primary care pediatric nurse practitioner is able to see a dark red fluid level between the cornea and iris on gross examination, but the child resists any exam with a light. Which action is correct?
A. Administer an oral analgesic medication.
B. Apply a Fox shield and reevaluate the eye in 24 hours.
C. Instill anesthetic eyedrops into the affected eye.
D. Refer the child immediately to an ophthalmologist.

Question 13

A school­age child is seen in the clinic after a fragment from a glass bottle flew into the eye. What will the primary care pediatric nurse practitioner do?
A. Refer immediately to an ophthalmologist.
B. Attempt to visualize the glass fragment.
C. Irrigate the eye with sterile saline.
D. Instill a topical anesthetic.

Question 14

During a well child assessment of an African­American infant, the primary care
pediatric nurse practitioner notes a dark red­brown light reflex in the left eye and a slightly brighter, red­orange light reflex in the right eye. The nurse practitioner will
A. dilate the pupils and reassess the red reflex.
B. order auto­refractor screening of the eyes.
C. recheck the red reflex in 1 month.
D. refer the infant to an ophthalmologist.

Question 15

During a well­baby assessment on a 1­week­old infant who had a normal exam
when discharged from the newborn nursery 2 days prior, the primary care pediatric nurse practitioner notes moderate eyelid swelling, bulbar conjunctival injections, and moderate amounts of thick, purulent discharge. What is the likely diagnosis?
A. Chemical­induced conjunctivitis
B. Chlamydia trachomatis conjunctivitis
C. Herpes simplex virus (HSV) conjunctivitis
D. Neisseria gonorrhea conjunctivitis